DRG Coding & Clinical Validation Analyst (I–III)

Byrne Dairy; City of Utica (NY); Hybrid; USD 65,346 - 117,622; Full time

Benefits offered by this job

Health insurance

Retirement plan

Wellness program

Paid time off

Job summary

A healthcare organization is seeking a Payment Integrity DRG Coding & Clinical Validation Analyst with extensive experience in acute facility-based clinical documentation. The role encompasses reviewing medical records for accuracy, conducting audits, and supporting compliance with coding guidelines. Candidates require an associate or bachelor’s degree in health information management and relevant coding certifications. The position may offer opportunities for remote work depending on the case.

Qualifications

• Minimum 3 years experience in claims auditing for acute facilities.
• Knowledge of MS-DRG and APR-DRG payment systems.
• Ability to analyze and audit acute inpatient claims.

Responsibilities

• Review medical records for coding and DRG assignment accuracy.
• Perform complex audits with minimal oversight.
• Provide training and guidance to team members.

Skills

ICD-10 coding expertise

Analytical skills

Problem-solving skills

Knowledge of medical claims billing

Education

Associate or bachelor’s degree in health information management

Coding Certification (RHIA, RHIT, CCS, or CIC)

Tools

Claims processing systems

Auditing tools

Job description

A healthcare organization is seeking a Payment Integrity DRG Coding & Clinical Validation Analyst with extensive experience in acute facility-based clinical documentation. The role encompasses reviewing medical records for accuracy, conducting audits, and supporting compliance with coding guidelines. Candidates require an associate or bachelor’s degree in health information management and relevant coding certifications. The position may offer opportunities for remote work depending on the case.